COVID-19 vaccination hesitancy in people affected by diabetes and strategies to increase vaccine compliance: A systematic narrative review and meta-analysis

Introduction: People affected by diabetes are at higher risk for complications from certain vaccine-preventable diseases. Suboptimal vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of diabetic patients who express hesitation to the COVID-19 vaccine worldwide.Methods: Seven studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases from 2020 to 2022. The following terms were used for the search strategy: (adherence OR hesitancy OR compliance OR attitude) AND (covid* OR SARS*) AND (vaccin* OR immun*) AND (diabet*).Results: The vaccine hesitation rate among persons with diabetes was 27.8 % (95 %CI = 15.6-41.9 %). In the comparison of vaccine hesitancy between sexes and educational status, the RRs were 0.90 (95 %CI = 0.71-1.15) and 0.88 (95 %CI = 0.76-1.02), respectively. The main reasons of unwillingness were lack of information, opinion that the vaccine was unsafe or not efficient, and fear of adverse events.Conclusions: In order to achieve a high vaccination coverage, multifactorial approach is needed, which requires major social, scientific and health efforts. The success of the vaccination campaign in this population depends on the capillarity and consistency of the interventions implemented.

Evaluation of computed tomography and pulmonary SOFA score: relationship of findings in patients with covid-19 and mortality in ICU

Objective: To evaluate the pulmonary severity of COVID-19 patients throug the SOFA score computed with pulmonary involvement in Chest Computed Tomography. Method: This is a descriptive epidemiological study conducted out in an Intensive Care Unit, which aimed to study the pulmonary treatment of COVID-19 patients through the calculation of the pulmonary SOFA score relating to Chest Tomography and whether these were related to clinical treatment. Results: The study population consisted of 704 patients, of which 43.7% were women and 56.2% men, with a mean age of 61 years and a mean hospitalization time of 13 days. Most patients had a pulmonary behavior of 75%, a pulmonary SOFA score of 2 and a PaO2/FiO2 ratio between 100 and 200. Conclusion: Patients who had more extensive pulmonary involvement/consequently had a lower PaO2/FiO2 ratio and remained longer hospitalized with a higher incidence of death © COPYRIGHT Servicio de Publicaciones - Universidad de Murcia

Incidence of SARS-COV-2 infection among swimming athletes: data from real life in Apulia (Italy), July 2020/ August 2021

Background. As other indoor sports facilities, swimming pools were closed in Italy from March to May 2020 and from October 2020 to July 2021 due to the outbreak of the COVID-19 pandemic;access to these facilities was restricted to athletes of national relevance. This decision was based on "precautionary principles” and without evidence of a high risk of SARS-COV-2 circulation among swimming pools' attendants. The aim of this paper is to describe the pattern of SARS-COV-2 circulation among swimming athletes in Apulia (Southern Italy). Study design. The study aims to investigate the hypothesis that attending a pool increases the risk of SARSCOV-2 infection. The outcome measure is the incidence of SARS-COV-2 infection among swimming athletes compared with the general population. Methods. This is a retrospective cross-sectional study carried out in Apulia, Southern Italy. The study was performed through the analysis of both the database of the Italian Swimming Federation and the SARS-COV-2 infections in Apulia Region, from July 2020 to August 2021. Results. Among 2,939 federally licensed athletes, 221 had an history of SARS-COV-2 infection from July 2020 to August 2021, with an incidence of 75.2 /1,000. In the general Apulian population, during the same time span, the incidence of SARS-COV-2 infection was 67.3/1,000 and - considering the incidence rate ratio - there is no difference between the two populations (IRR=1.1;95% CI=0.9-1.3;p>0.05). Conclusions. The incidence of SARS-COV-2 infection in Apulian swimmers showed no significant differences with the general population. © Società Editrice Universo (SEU), Roma, Italy

The effect of positive pressure ventilation on Acute Kidney Injury (AKI) in COVID-19 Acute Respiratory Distress Syndrome (ARDS). An observational study

Background: Acute kidney injury (AKI) is a common complication of COVID-19 ARDS and is associated with greater risk of mortality (1)). In addition to the direct tubular injury mediated by the virus, indirect mechanisms play a role in AKI development. Positive pressure ventilation, by increasing intrathoracic pressure, leads to a decreased venous return to the heart and to a reduced cardiac output (2). In addition, elevated central venous pressure (CVP) may result in elevated tubular hydrostatic pressure in the encapsulated kidney, which reduces glomerular filtration rate and oxygen delivery (3). We hypothesized that elevated intrathoracic pressure, determined by positive pressure ventilation is associated with an increased risk of AKI. The aim of the study is to assess the association between hemodynamics and ventilatory parameters set during mechanical ventilation and AKI in patients with COVID-19 ARDS. Method(s): This is single center retrospective observational study performed at Papa Giovanni XXIII Hospital Bergamo (Italy). Consecutive patients were enrolled with a diagnosis of COVID-19 and ARDS managed with invasive mechanical ventilation. If patients developed AKI (defined according to KDIGO definition) within 14 days of ICU stay were included in "AKI group", otherwise were classified in "non-AKI group". Demographic characteristics, lab tests and hemodynamic [mean arterial pressure (MAP) and central venous pressure (CVP), fluid balance] and ventilatory parameters [positive end-expiratory pressure (PEEP), plateau pressure (PPlat)] were compared between group using Mann Whitney test. Data are presented as median and 95% CI. Only data registered until the day of the AKI occurrence, in patients in AKI group, or until the day corresponding to the median days between ICU admission and the AKI occurrence calculated before for patients in non-AKI group, were considered for the statistical analysis. Result(s): Among the 140 patients included in the analysis, AKI occurred in 70 (48%) patients and 27 (19%) required continuous renal replacement therapy (CRRT). Table 1 shows comparison between the two groups. Patients in AKI group were older, had higher prevalence of obesity, hypertension and diabetes, had lower MAP and received a greater amount of fluid and furosemide compared to patients in non-AKI group (p<0.05). Only a trend toward a greater CVP was observed in patients with AKI, without reaching a significant difference. Both PEEP and Pplat were set higher in patients with AKI, while the severity of lung disease, measured by PaO2/FiO2 were not different between the two groups. Conclusion(s): In our cohort, higher pressure ventilation was associated with an increased risk of AKI.

In-hospital mortality in non-COVID patients: women die more

Premise and Study aim: In Italy at the end of 2020 more than 30.000 deaths were observed not attributable to COVID;we wanted to test this hypothesis in our non-COVID internal medicine, benchmark for an area of about 150.000 inhabitants. Materials and Methods: We compared the number of discharges and deaths hospitalized in our UOC in the year of the pandemic, 2020 and 2021, respect to 2019, and we assessed any differences in mortality between the years and gender, and if these had statistical significance. Results: Total mortality showed an increasing trend from 2019 to 2021 (statistically not significant);hospital mortality in males is reduced in 2020 and unchanged in 2021, mortality in females showed a clear increasing trend (OR:1.58, IC:0.96-2.06) in 2019, statistically significant (OR:1.9, IC:1.2-3.1) in 2021. Conclusions: Delayed hospitalization for “fear of infection” of more serious patients and with lower chances of survival, together with the drastic reduction/absence of territorial outpatient diagnosis and treatment activities starting from March 2020, with further impact on chronicity in 2021, can be considered responsible for the increase in in-hospital mortality compared to 2019, detected in our patients. Data become statistically significant in female population, and it is attributable both to a greater fragility (living alone, less economic resources, less education) and the role of main care givers in the pandemic, continuing to guarantee assistance to all family members, in particular to the partner, even if detrimental of self health.

Incidence of SARS-COV-2 infection among swimming athletes: data from real life in Apulia (Italy), July 2020/ August 2021

BACKGROUND: As other indoor sports facilities, swimming pools were closed in Italy from March to May 2020 and from October 2020 to July 2021 due to the outbreak of the COVID-19 pandemic;access to these facilities was restricted to athletes of national relevance. This decision was based on "precautionary principles" and without evidence of a high risk of SARS-COV-2 circulation among swimming pools' attendants. The aim of this paper is to describe the pattern of SARS-COV-2 circulation among swimming athletes in Apulia (Southern Italy). STUDY DESIGN: The study aims to investigate the hypothesis that attending a pool increases the risk of SARSCOV- 2 infection. The outcome measure is the incidence of SARS-COV-2 infection among swimming athletes compared with the general population. METHODS: This is a retrospective cross-sectional study carried out in Apulia, Southern Italy. The study was performed through the analysis of both the database of the Italian Swimming Federation and the SARS-COV-2 infections in Apulia Region, from July 2020 to August 2021. RESULTS: Among 2,939 federally licensed athletes, 221 had an history of SARS-COV-2 infection from July 2020 to August 2021, with an incidence of 75.2 /1,000. In the general Apulian population, during the same time span, the incidence of SARS-COV-2 infection was 67.3/1,000 and - considering the incidence rate ratio - there is no difference between the two populations (IRR=1.1;95% CI=0.9-1.3;p>0.05). CONCLUSIONS: The incidence of SARS-COV-2 infection in Apulian swimmers showed no significant differences with the general population.

Tomographic characteristics of lung lesions in hospitalized patients with COVID-19 and its prognostic value

The severity of lung involvement on chest tomography (CT) images in COVID-19 patients may have a prognostic value. This study assesses the type, severity and frequency of the different images of lung CT in hospitalized patients with COVID-19, and the differences in clinical characteristics and in-hospital outcomes, according to the CT severity score. This represents an observational study (retrospective cohort) of hospitalized patients with COVID-19. The ISARIC-WHO form was used to collect data. The type of lung lesions, affected lobes, and total CT severity score were determined at hospital admission. The first, second and third quartiles of the total CT score were calculated to divide the sample into four equal parts (Q1, Q2, Q3 and Q4). A total of 556 patients were included, 336 men (60.4%) and 220 women (39.6%), with a mean age of 61.9 +/- 15.8 years;and 532 of them had CT scan at admission. Patients in the more severe quartiles had more days of symptoms evolution (Q1 6.4 +/- 3.5, Q2 7.9 +/- 4.1, Q3 8.2 +/- 4.1, Q4 8.1 +/- 4.4), desaturation (Q1 95.3 +/- 3.7, Q2 94.4 +/- 3.1%, Q3 91.7 +/- 4.8%, Q4 86.5 +/- 9.1%), alterations of inflammatory markers, hospital stay (Q1 6.4 +/- 2.9, Q2 7.4 +/- 4.1, Q3 9.6 +/- 5.8, Q4 13.1 +/- 10.4 days), admission to ICU (Q1-2.5%, Q2-5.8%, Q3-12.5%, Q4-49.1%), mortality (Q1-3.8%, Q2-4.5%, Q3-9.4%, Q4-33.3%), mixed CT lesions (ground glass opacity-consolidation), linear opacities, crazy-paving pattern, reverse halo sign, and bronchiectasis. The total CT score significantly correlated with leukocyte, neutrophil and lymphocyte counts, and with other inflammatory markers. Semi-quantitative evaluation of pulmonary involvement in the initial chest CT can help to establish the severity of the case and predict relevant clinical outcomes in COVID-19 patients.

Antibiotic prescription in hospitalized patients with covid-19 in a private hospital in caracas: Retrospective study

Background: There is little information on the prevalence of bacterial coinfection and use of antibiotics in hospitalized CO-VID-19 patients. The present study assesses the frequency of in-hospital antibiotic prescription, the bacterial cultures im-plementation and the clinical characteristics of patients with COVID-19 according to the use of antibiotics. Methods: Ret-rospective, observational study of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data col-lection. Results: 145 patients were included, 95 men and 50 women, with a mean age 63.8±16.0 years. 79/145 (54.5%) patients received antibiotics, 52/145 (35%) had samples for culture and 49/145 (33.8%) were blood cultures. Pathogenic bacteria were isolated only in 7% of the patients. The patients with antibiotics had worse oxygenation, chest tomography and inflammatory markers, more admission to ICU, deaths, and prolonged hospital stay. Conclusion: Our results do not support the initial widespread use of antibiotics in hospitalized COVID-19 patients without knowing the pathogen and its susceptibility.

Hospitalized patients with COVID-19: One-year pandemic report

Background: There is limited information about the variations of the clinical characteristics and outcomes in hospitalized patients with COVID-19 during the pandemic. No study has evaluated these changes in our region. Objective: To assess the clinical characteristics and outcomes of adult hospitalized patients with COVID-19 during the first year of the pandemic. Methods: This is a retrospective, observational study. Medical charts of hospitalized patients with COVID-19 at the Hospital Centro Médico de Caracas were reviewed to obtain information about their clinical characteristics. Results: A total of 454 patients were included, 278 men (61 %) and 176 women (39 %), with an average age of 61.97±15.95 years, previous duration of symptoms 7.38 ± 4.01 days, chest CT score 11.49±5.80, and hospital stay 8.30±5.11 days. 59.8 % of the patients had severe-critical disease, 40.2 % mild-moderate, 15.86 % were admitted to the ICU, 81.2 % were discharged and 9.5 % had died. The curve of hospitalized cases was bimodal, identifying two waves: The first between July-September 2020 (peak in August with 59 cases), the second larger and longer between December 2020 and April 2021 (peak in March 2021 with 140 cases). The length of hospital stay remained stable over one year, while mortality decreased progressively (highest value in August 2020, 26.4 % and the lowest in March 2021, 5.4 %). Conclusion: The results show the behavior of hospitalized patients with COVID-19 during a year of the pandemic in our population. It is reasonable that the decline in mortality rate is the result of changes in the age of patients, the disease severity, and provision of care during the pandemic. © 2021 Academia Nacional de Medicina. All rights reserved.

Clinical characteristics of patients hospitalized with COVID-19 according to glycemia levels: Case series

Hyperglycemia, with or without diabetes, is associated with complications in hospitalized patients with COVID-19. There is no information regarding this problem in our region. This study was aimed to compare the characteristics and in-hospital clinical course of patients with a probable diagnosis of COVID-19, with and without hyperglycemia during the hospitalization. This is a retrospective, observational study of clinical records review of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data collection. Hyperglycemia was defined as a fasting value >= 140 mg/dL according to standard glycaemia targets in hospitalized patients. A total of 148 patients were included, 97 (65.5%) men and 51 (34.5%) women, with a mean age of 64.1 +/- 16.1 years;of which 42/148 (28.4%) patients reported previous diabetes, 60/148 (40.5%) patients had hyperglycemia during the hospitalization and 32/60 (53.3%) of these cases did not report previous diabetes. The patients with hyperglycemia were older, received more frequently systemic corticosteroids (96.6 vs 82.6%;p=0.01), and antibiotics (68.3 vs 44.3%;p=0.01), had worse baseline oxygenation parameters (SpO(2) 88.1 +/- 1,1.7%;vs 92.8 +/- 5.5%;p=0.02, PaO2/FiO(2), 194.4 +/- 119.7 vs 270.9 +/- 118.3;p<0.001), higher total lung severity score in the chest CT (14.9 +/- 5.7 vs 11.1 +/- 6.3;p<0.001) and higher levels of baseline inflammatory markers (CRP 6.73 +/- 3.61 vs 5.08 +/- 4.21;p<0.01, LDH 342.9 +/- 118.4 vs 296.5 +/- 161.4;p=0.01 and Ferritin 687.7 +/- 373.2 vs 542.6 +/- 395.3;p=0.01). Mortality (34.5 vs 10.7%;p<0.001) and admission to ICU (43.3 vs 7.9%;p<0.001) were higher in patients with hyperglycemia. Hyperglycemia in hospitalized patients with COVID-19 is a marker of severe disease and poor prognosis.

COVID-19 and pneumothorax: a multicentre retrospective case series

Introduction: Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients). Methods: Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival. Results: 71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1 +/- 6.5%) or isolated pneumomediastinum (53.0 +/- 18.7%;p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5 +/- 7.7% versus females 68.4 +/- 10.7%;p=0.619). Patients aged >= 70 years had a significantly lower 28-day survival than younger individuals (>= 70 years 41.7 +/- 13.5% survival versus <70 years 70.9 +/- 6.8% survival;p=0.018 log-rank). Conclusion: These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible.

CHANGES IN CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS HOSPITALIZED WITH COVID-19 DURING TWO YEARS OF THE PANDEMIC: EXPERIENCE IN A VENEZUELAN HOSPITAL

Objectives. To determine changes in the clinical characteristics and in-hospital outcomes of patients hospitalized for COVID-19 in a private hospital in Caracas during two years of the pandemic. Materials and Methods. Retrospective, observational study of patients hospitalized for COVID-19. We evaluated the correspondence between waves of hospital admissions and circulating variants of SARS-CoV-2 in the general population of the Capital District and Miranda state. Results. A total of 1025 patients (569 men and 456 women) were included, with a mean age of 62.9 SD: 16.2 years. Four waves of hospital admissions were identified: first (March-No-vember 2020) 150/1025 (14.6%) cases;second (December 2020 to May 2021) 415/1025 (40.5%) cases;third (June-December 2021) 344/1025 (33.6%) cases;fourth (January-February 2022) 116/1025 (11.3%) cases. The mean age was higher in the fourth wave (first: 64.0±15.7, second: 61.4±15.8, third: 62.1±16.5, and fourth wave: 68.5±16.4), while the proportion of male patients (first: 66.7%, se-cond: 58.8%, third: 50.3%, and fourth wave: 44.8%), patients with severe-critical illness (first: 65.3%, second: 57%, third: 51.7%, and fourth wave: 44.8%), in-hospital stay (first: 9.1±6.0, second: 9.0±7.3, third: 8.8±7.7, and fourth wave: 6.9±5.0 days), ICU admissions (first: 23.3%, second: 15.7%, third: 14.0%, and fourth wave: 11.2%;p=0.027) and mortality (first: 21. 8%, second: 10.7%, third: 9.1%, and fourth wave: 7.1%;p<0.001) progressively decreased over time. Conclusions. The results show lower frequency of severe cases and improvement of in-hospital outcomes in two years of the pandemic. Changes in circulating variants, improvements in disease management and vaccination are likely to have influenced these results. © 2022, Instituto Nacional de Salud. All rights reserved.